Fluorescence Patterns and Histopathology Correlation in Rare Pediatric Liver Tumors Using Indocyanine Green Near-Infrared Imaging

Background Indocyanine green near-infrared (ICG-NIR) fluorescence imaging is well established in pediatric hepatoblastoma, but its application in rare liver tumors has not been widely reported. This study aims to summarize clinical experience and assess the safety, feasibility, and histopathological correlations of the technology in detecting pediatric rare liver tumors. Methods We retrospectively reviewed 23 children with rare liver tumors who underwent ICG-NIR fluorescence-guided resection between January 2020 and September 2023. ICG was administered intravenously 0–3 days before surgery. Intraoperative ICG-NIR fluorescence imaging was categorized as total, partial, rim, or negative, and correlated with histological subtype. Resection margins and perioperative outcomes were recorded. Results Among the tumors analyzed (benign 52.2%, malignant 34.8%, metastatic 13.0%), the fluorescence patterns were total (39.1%), partial (17.4%), rim (34.8%), and negative (8.7%). Tumors of hepatocytic origin predominantly showed a total fluorescence pattern (81.8%), whereas non-hepatocytic malignancies more frequently exhibited rim patterns (66.7%). Hepatic mesenchymal hamartomas, despite their mesenchymal origin, showed a total fluorescence pattern, likely due to the preservation of bile duct structures. Except for the two cases of neuroblastoma liver metastases, all 21 children underwent complete tumor excision (R0). No child experienced adverse reactions related to ICG. Conclusions ICG-NIR fluorescence imaging is a safe and effective tool in surgery for rare pediatric liver tumors. Fluorescence patterns correlate with tumor histopathology and can aid intraoperative differential diagnosis, although image quality may be affected by tumor depth, prior treatments, and equipment sensitivity.